Objective:To investigate the clinical efficacy of fixation with a modified double-pulley anchor suture in the treatment of Rockwood type Ⅱ patella fractures.Methods:A retrospective study was conducted to analyze the 60 patients with Rockwood type Ⅱ patellar fracture who had been admitted to Department of Joint Surgery, The Hospital Affiliated to Qingdao University between November 2021 and November 2023. The cohort included 31 males and 29 females, with an age of (53.5±10.4) years. According to the treatment methods, the patients were divided into a study group (28 cases) which was treated by traction reinforcement of the terminal anchor suture in addition to fixation with a double-pulley anchor suture, and a control group (32 cases) which was treated by the traditional Kirschner wire tension band technique. The operation time, intraoperative blood loss, incision length, reoperation rate, complication rate, fracture healing, and visual analog scale (VAS) pain scores and Bostman scores at postoperative 1 month, 3 months, and 6 months and at the last follow-up were compared between the 2 groups.Results:No statistically significant differences were observed in the preoperative general data between the 2 groups, indicating that the 2 groups were comparable ( P>0.05). All patients were followed up for (12.8±1.4) months postoperatively. The study group demonstrated significantly lower intraoperative blood loss [(25.9±6.8) mL] than the control group [(40.5±11.6) mL], and a significantly lower reoperation rate (0) than the control group [53.1% (17/32)] ( P<0.05). There was no statistically significant difference between the 2 groups in operation time, incision length, incidence of complications, as well as in VAS pain scores or Bostman scores at postoperative 1 month, 3 months, or 6 months or at the last follow-up (all P>0.05). Fractures healed in both groups at 6 months postoperatively. Conclusions:For patients with Rockwood type Ⅱ patellar fracture, fixation with modified double-pulley suture anchor can achieve good clinical efficacy. Compared to the traditional Kirschner wire tension band technique, the modified mothed significantly reduces intraoperative blood loss and avoids secondary trauma caused by a second surgery for implant removal.

Purpose To investigate the clinicopathological features,differential diagnosis,and prognosis of breast carcinoma within fibroadenoma(FA).Methods A retrospective analysis was performed on the clinical and imaging data of 21 cases of FA-associated carcinoma.HE staining,immunohistochemistry using the EnVision method,and next-generation sequencing were employed to assess the clinicopathological characteristics and genetic alterations,with a review of the relevant literature.Results All patients were female,aged 21-67 years,with a median age of 48 years.Clinically,all lesions presented with well-circumscribed mass lesions.On imaging,12 cases demonstrated punctate or coarse calcifications,while 3 cases exhibited locally indistinct margins.Pathological examination revealed that the tumors had an average maximum diameter of 2.25 cm,with a gray-white nodular cut surface resembling FA.Microscopically,there was proliferation of either epithelial or spindle cells.The pathological diagnosis was FA-associat-ed in situ carcinoma in 16 cases(15 cases of low-grade ductal carcinoma in situ and 1 case of lobular carcinoma in si-tu),and invasive carcinoma in 5 cases(comprising 2 cases of invasive carcinoma-no special type,1 case of invasive lobular carcinoma,1 case of low-grade adenosquamous carcinoma and 1 case of fibromatosis-like metaplastic carcino-ma).In 18 cases,the carcinoma was confined within the FA,whereas in 3 cases the tumor locally extended beyond the FA,and 1 case exhibited ipsilateral axillary lymph node metastasis.Immunophenotypically,tumor cells in in situ carcinomas were negative for CK5/6,while the myoepithelial cells were p63-positive,and both estrogen receptor(ER)and progesterone receptor(PR)were diffusely and consistently positive.In invasive carcinoma,both ductal and lobular subtypes were ER and PR positive and HER2 negative.Conversely,in the low-grade adenosquamous carcinoma and fi-bromatosis-like metaplastic carcinoma,ER,PR,and HER2 were all negative,with p63 and CK5/6 positivity.Two ca-ses were negative for mismatch repair protein PMS2.Six cases had a family or personal history of malignant tumors;a-mong the 5 cases that underwent next-generation sequencing,2 cases harbored germline BRCA2 mutations,2 cases had germline PMS2 mutations,and 1 case exhibited no definitive genetic alteration.Conclusion Carcinoma arising within FA exhibits atypical clinical and imaging features.In patients with high-risk factors for breast cancer or family history of malignancy,or when calcifications are observed on imaging,prompt excision and biopsy are recommended.Recogniz-ing the abnormal morphology within FA and the use of immunohistochemistry are essential for accurate diagnosis,with careful differentiation from spindle cell metaplastic carcinoma and low-grade adenosquamous carcinoma.Overall,the prognosis is relatively favorable,and treatment should be tailored according to tumor type,molecular subtype,and stage.

Purpose To investigate the clinicopathological features,differential diagnosis,and prognosis of breast carcinoma within fibroadenoma(FA).Methods A retrospective analysis was performed on the clinical and imaging data of 21 cases of FA-associated carcinoma.HE staining,immunohistochemistry using the EnVision method,and next-generation sequencing were employed to assess the clinicopathological characteristics and genetic alterations,with a review of the relevant literature.Results All patients were female,aged 21-67 years,with a median age of 48 years.Clinically,all lesions presented with well-circumscribed mass lesions.On imaging,12 cases demonstrated punctate or coarse calcifications,while 3 cases exhibited locally indistinct margins.Pathological examination revealed that the tumors had an average maximum diameter of 2.25 cm,with a gray-white nodular cut surface resembling FA.Microscopically,there was proliferation of either epithelial or spindle cells.The pathological diagnosis was FA-associat-ed in situ carcinoma in 16 cases(15 cases of low-grade ductal carcinoma in situ and 1 case of lobular carcinoma in si-tu),and invasive carcinoma in 5 cases(comprising 2 cases of invasive carcinoma-no special type,1 case of invasive lobular carcinoma,1 case of low-grade adenosquamous carcinoma and 1 case of fibromatosis-like metaplastic carcino-ma).In 18 cases,the carcinoma was confined within the FA,whereas in 3 cases the tumor locally extended beyond the FA,and 1 case exhibited ipsilateral axillary lymph node metastasis.Immunophenotypically,tumor cells in in situ carcinomas were negative for CK5/6,while the myoepithelial cells were p63-positive,and both estrogen receptor(ER)and progesterone receptor(PR)were diffusely and consistently positive.In invasive carcinoma,both ductal and lobular subtypes were ER and PR positive and HER2 negative.Conversely,in the low-grade adenosquamous carcinoma and fi-bromatosis-like metaplastic carcinoma,ER,PR,and HER2 were all negative,with p63 and CK5/6 positivity.Two ca-ses were negative for mismatch repair protein PMS2.Six cases had a family or personal history of malignant tumors;a-mong the 5 cases that underwent next-generation sequencing,2 cases harbored germline BRCA2 mutations,2 cases had germline PMS2 mutations,and 1 case exhibited no definitive genetic alteration.Conclusion Carcinoma arising within FA exhibits atypical clinical and imaging features.In patients with high-risk factors for breast cancer or family history of malignancy,or when calcifications are observed on imaging,prompt excision and biopsy are recommended.Recogniz-ing the abnormal morphology within FA and the use of immunohistochemistry are essential for accurate diagnosis,with careful differentiation from spindle cell metaplastic carcinoma and low-grade adenosquamous carcinoma.Overall,the prognosis is relatively favorable,and treatment should be tailored according to tumor type,molecular subtype,and stage.

Objective:To investigate the clinical efficacy of fixation with a modified double-pulley anchor suture in the treatment of Rockwood type Ⅱ patella fractures.Methods:A retrospective study was conducted to analyze the 60 patients with Rockwood type Ⅱ patellar fracture who had been admitted to Department of Joint Surgery, The Hospital Affiliated to Qingdao University between November 2021 and November 2023. The cohort included 31 males and 29 females, with an age of (53.5±10.4) years. According to the treatment methods, the patients were divided into a study group (28 cases) which was treated by traction reinforcement of the terminal anchor suture in addition to fixation with a double-pulley anchor suture, and a control group (32 cases) which was treated by the traditional Kirschner wire tension band technique. The operation time, intraoperative blood loss, incision length, reoperation rate, complication rate, fracture healing, and visual analog scale (VAS) pain scores and Bostman scores at postoperative 1 month, 3 months, and 6 months and at the last follow-up were compared between the 2 groups.Results:No statistically significant differences were observed in the preoperative general data between the 2 groups, indicating that the 2 groups were comparable ( P>0.05). All patients were followed up for (12.8±1.4) months postoperatively. The study group demonstrated significantly lower intraoperative blood loss [(25.9±6.8) mL] than the control group [(40.5±11.6) mL], and a significantly lower reoperation rate (0) than the control group [53.1% (17/32)] ( P<0.05). There was no statistically significant difference between the 2 groups in operation time, incision length, incidence of complications, as well as in VAS pain scores or Bostman scores at postoperative 1 month, 3 months, or 6 months or at the last follow-up (all P>0.05). Fractures healed in both groups at 6 months postoperatively. Conclusions:For patients with Rockwood type Ⅱ patellar fracture, fixation with modified double-pulley suture anchor can achieve good clinical efficacy. Compared to the traditional Kirschner wire tension band technique, the modified mothed significantly reduces intraoperative blood loss and avoids secondary trauma caused by a second surgery for implant removal.

Objective:To investigate the prevalence and its related factors of thyroid nodules in elderly residents in Tongzhou District of Beijing.Methods:This is a cross-sectional study with cluster sampling.A total of 3 639 elderly volunteers aged 60 years and over receiving annual multiphasic health checkups were enrolled in Yongshun, Tongzhou District of Beijing from June to December 2017.A uniformly designed questionnaire was used to investigate the subject's basic information and previous medical history.All volunteers received a B-ultrasound examination of the thyroid gland, and were divided into the nodular group and non-nodular group based on the results of the B-ultrasound.The differences between the two groups in blood pressure, body mass index, triglycerides, total cholesterol, fasting blood glucose, thyroid peroxidase antibodies, urine iodine and other indicators were compared so as to analyze the risk factors for thyroid nodules.Results:A total of 3 639 elderly residents were included.The prevalence of thyroid nodules was 49.68%(1 808/3 639). Univariate analysis showed that there were significant differences between nodule group and non-nodule group in the age, gender, systolic blood pressure, body mass index, urea nitrogen, uric acid, aspartate aminotransferase, triglycerides, thyroid stimulating hormone and carcinoembryonic antigen( P<0.05). Multivariate Logistic regression analysis showed that women( OR=1.577, 95% CI: 1.358-1.832), age( OR=1.025, 95% CI: 1.012-1.038), body mass index( OR=1.032, 95% CI: 1.013-1.052)were risk factors for thyroid nodules.Increasing levels of urea nitrogen( OR=0.945, 95% CI: 0.902-0.990), thyroid stimulating hormone( OR=0.925, 95% CI: 0.882-0.970)and carcinoembryonic antigen( OR=0.967, 95% CI: 0.941-0.994)were protective factors for thyroid nodules. Conclusions:Women and obesity are risk factors for thyroid nodules and increasing levels of thyroid stimulating hormone, urea nitrogen and carcinoembryonic antigen may be unique protective factors for thyroid nodules in the elderly.

[ ABSTRACT] AIM:To investigate the effect of atorvastatin on the development of heart failure after myocardial infarction and the association with sodium-calcium exchanger (NCX) expression.METHODS:The model of heart failure was established by ligation of the anterior descending coronary artery for 8 weeks.The rats were randomly divided into con-trol group, heart failure group, and atorvastatin group.Either atorvastatin (10 mg· kg-1· d-1) or vehicle was orally ad-ministered to the rats on the next day after the surgery .The left ventricular function and NCX expression were analyzed 8 weeks after ligation .Neonatal rat cardiomyocytes were cultured to investigate the effect of atorvastatin on the changes of cal -cium concentration induced by hypoxemia .RESULTS: A decrease in left ventricular diastolic dimension , an increase in left ventricular fractional shortening , and reductions of BNP level and NCX expression were observed in atorvastatin group . The hypoxemia-induced calcium overload in cultured cardiomyocytes was inhibited by atorvastatin , and it was inhibited by the inhibitor of NCX .CONCLUSION:Atorvastatin treatment improves cardiac function , which may be related to the ex-pression and function of sodium calcium exchanger in heart failure .

Objective To investigate whether the new mechanically-activated (MA) cation channel Piezo 1 protein can cause the apoptosis of human chondrocytes under compressive loading,using a Flexercell unit by activating MAPK/ERK5 signal pathway.Methods Primary human chondrocytes were isolated,cultured,and then subjected to the static compressive loading for 2 h,12 h,24.h and 48 h,respectively.The GsMTx4,which is the special inhibitor of the Piezo1 protein and the BIX02188,which is the inhibitor of the ERK5 served as the inhibitor group.The immunofluorescence was used to locate the expression of the Piezo 1 protein.The expressions of Piezo1 and ERK5 were assessed by reverse transcription-polymerase chain reaction (RT-PCR),as well as the apoptosis gene B cell lymphoma/leukemia-2 (Bcl-2),Bcl-associated X protein (Bax) and Bcl-associated death promoter (BAD).In addition,Piezo1 inhibitor,GsMTx4,was used to block the MA cation channel Piezo1,served as the inhibitor group.AVPI was used to detect the apoptosis of the OA chondrocytes.Results The location of the Piezo1 was expressed in nucleus and cytoplasm of chondrocytes.The expression of the Piezo1,ERK5,BAD,and Bax mRNA in the OA chondrocytes is weak.The 12 h stretch force group was significant increased,and the 24 h stretch force group was the highest expression.However,the expression of the 48 h group was decreasing.The expression of the Bcl-2 in the 12 h group was decreasing,and the 12 h stretch force group was the lowest expression while the 24 h stretch force group was increasing.In the GsMTx4 group,the expression of the Piezo1,ERK5,BAD,Bax was decreasing while the Bcl-2 was increasing.In the BIX02188 group,the expression of the ERKS,BAD,Bax was increasing while the Bcl-2 was decreasing,while the expression of the Piezo1 was not change.The result of AV-PI shown that the 2 h stretch force group increased early stage of apoptosis.The 12 h stretch force group increased late stage of apoptosis,and the 24 h stretch force group's apoptotic rate was the highest.However,the apoptotic rate of the 48 h group was lower than the 24 h stretch force group.The GsMTx4 could inhibit the late stage of apoptosis.Conclusion Piezo 1 plays an important role in the apoptosis of human chondrocyte through the MAPK/ERK5 signal pathway.

Objective To build up one bonus shares method of improvi ng nursing quality in order to simulate nurse′s the inner enthusiasm.Methods The competence model and assessment system were established for one important weight for bonus sharing of competence qualified of nursing staff,competence coefficient and performance assessment.Results The implementation of performance assessment improved nurse′s satisfaction from 76.3% to 89.2%,while the parent′s satisfaction increased from 84.3% to 93.0%(χ2 =1 3.070,9.766;P <0.05).Conclusions The bonus shares method is scientific and reasonable,which can dig out the potential of nursing staff and is worthy of promotion.

BACKGROUND:As lumbar spine biomechanics research is unceasingly thorough and the constant development of related fusion and dynamic fixation device, the spine fusion technique which is represented by artificial disc replacement is a new choice to the spine surgeons. Therefore, it is particularly important to design reasonable artificial intervertebral disc. OBJECTIVE:To establish the finite element model of the new artificial disc replacement of the lumbar motion segment for further biomechanical study. METHODS:The L3-4 thin-section CT images of a healthy male volunteer was selected, combined with human anatomy data and applied the reverse engineering technology to rebuild the lumbar spine model with medical image software Mimics and tool software Geomagic Studio. The three-dimensional model of the silicone artificial disc was converted into a finite element model through software ANSYS12.0. RESULTS AND CONCLUSION:Through CT scanning, digital image processing and computer-aided design, the three-dimensional model of the lumbar motion segment and the finite element model of artificial disc replacement were successful y established. The finite element model contained 691 085 units and 1 008 913 nodes which could be applied constraint and load and could be used for spinal biomechanics and the further research of the new artificial intervertebral disc.

Objectives To evaluate the effectiveness of bedside noninvasive scoring system in diagnosis of coronary heart disease (CAD).MethodsSix hundred and twelve patients with suspected CAD in our hospital were enrolled (343 males and 269 females) from September 2008 to October 2010,with an average age of 55 ± 7 y.The detailed history was taken; physical examination,resting electrocardiogram,blood biochemistry,treadmill exercise test and/or 12 lead Holter monitoring,64 or 256 rows CT coronary artery imaging and coronary artery angiography were performed in all patients.The risk factors for CAD were screened by multiple questionnaire surveys with Delphi method.The risk factors were stratified according to the results of expert survey: heavy smoking,diabetes mellitus,typical angina,positive treadmill exercise test and positive Holter monitoring electrocardiogram were included in the highest risk factors with an integrated scores of 8 ; dyslipidemia of 3 items,hypertension complicated with left ventricular hypertrophy were high risk factors with an integrated scores of 6; males≥40 y,medium smoking,dyslipidemia of 2 items,pathoglycemia,heavy drinking,positive ECG and post-menopause females were moderate risk factors with integrated scores of 4; Low risk factors contain moderate drinking and dyslipidemia of item,were classified as low risk factors with an integrated scores of 2. The bedside noninvasive scoring system was evaluated in all patients and the results were compared with those from multi-slice spiral CT or coronary angiography.ResultsWhen integrated score ≥ 24 was set as the cut-off level for diagnosis of CAD,thesensitivity,specificity,positive predictive value and accuracy were 89.95％,85.63％,94.03％and 88.73％ respectively.When integrated score≤ 14 was set as the exclusion criteria of CAD,the sensitivity,specificity,positive predictive value and accuracy were of 93.10％,82.86％,98.09％ and 84.80％ respectively.The accuracy was lower than that of multi-slice spiral CT or coronary angiography( P ＜0.05 ).ConclusionsThe bedside noninvasive scoring system is effective for preliminary diagnose of CAD,but need to be further improved.